Myth #1 - "Kids aren't little adults."
- Less a myth and more a good idea gone awry.
- We don't need to consider kids to be like aliens.
- Just take into account the anatomic and physiologic differences, but don't let them frighten you.
- They are a unique patient population (similar to all of your other unique patient populations).
Myth #2 - "IVF are faster than ORT."
--IVF are effective and often expected, but not always easy.
--Painful, makes unhappy parents and unhappy patients.
--ED LOS: ORT = 225 vs IVF = 358.
Myth #3 - "Lidocaine makes LP worse."
-- Neonates do feel pain, have greater sensitivity, and are more susceptible to long term effects.
-- EMLA is safe, reduces pain during LP.
-- Makes your job easier!! (keeps them from wiggling)
Myth #4 - "To hold for LP, bend them into a donut."
-- Don't do this.
-- Hyperflexed neck leads to SUBOPTIMAL AIRWAY ALIGNMENT.
-- Best airway position is sitting up with legs flexed and neck neutral.
Myth #5 - You can adjust for RBCs in the "Bloody tap."
-- Correct with 1:500 for WBC, etc etc -- these formulas don't work.
-- When concerned for meningitis, be conservative WBCs.
-- Do not adjust the WBC for the RBC in a traumatic LP. Use the total WBC.
Myth #6 - "Nebulizers are better than MDI."
-- Evidence shows that MDI are AT LEAST as good as nebs, if not better.
-- MDI is faster and reinforces good MDI use, which can help prevent patients from needing to return to the ED.